| NPI | 1902989122 |
|---|---|
| Professional Name | BO TRAVIS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IL 071.008003) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180003461) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2011-01-17 |